Clinical management of patients with invasive cervical cancer following a negative Pap smear

Among 535 patients with invasive cervical carcinoma seen between January 1975 and June 1986, 26 were found to have developed the disease within six months (65 percent), 35 within 12 months (88 percent), 37 within 13 months (93 percent), and three developed the disease within 17 months after a negative Pap smear. Eighty-eight percent of these 40 patients were under age 40 at diagnosis. Rapidly progressive cancers are highly resistant to radiation therapy. Seven stage IB patients treated only with radiation died within nine to 29 months after initial therapy. By contrast, 15 patients treated by radical hysterectomy and four by radical hysterectomy and post-surgical radiation were alive with no evidence of disease from six to 109 months after surgery (median, 30 months). Six of nine patients with stage II to IV disease treated with radiation have died; the remaining three are alive. One patient is well 14 months after therapy, but two others have developed metastases seven and 12 months after treatment. Surprisingly, 37 of 40 patients had symptoms of pain, bleeding, and discharge at the initial diagnosis, but their physicians had a false sense of security because of a recent negative Pap smear. Early biopsy diagnosis and radical hysterectomy with bilateral pelvic lymphadenectomy is the most effective management for this cancer.     

Sex Differences in the Association of Thigh Fat and Metabolic Risk in Older Adults

We have previously shown a favorable association of subcutaneous leg fat with markers of insulin resistance and dyslipidemia in postmenopausal women. It is not known whether there is a sex dimorphism in the association of lower‐body adiposity with reduced metabolic risk. Thus, our primary aim was to determine whether the favorable association of thigh subcutaneous fat, independent of abdominal fat, is also observed in older men. Mid‐thigh and abdominal fat areas were measured by computed tomography (CT) in 108 older men and postmenopausal women (mean ± s.d.; 69 ± 7 years). Additionally, trunk and leg fat mass (FM) were measured by dual‐energy X‐ray absorptiometry (DXA). Markers of insulin resistance and dyslipidemia were determined from oral glucose tolerance tests and lipid and lipoprotein measurements, respectively. Outcomes were fasted and postchallenge (area under the curve, AUC) insulin (INS_AUC) and glucose (GLU_AUC), product of the insulin and glucose AUC (INS_AUC × GLU_AUC), triglycerides (TG), and high‐density lipoprotein (HDL)‐cholesterol. Consistent with our previous findings in postmenopausal women, adjusting for DXA trunk FM revealed a favorable association of DXA leg FM with the metabolic risk outcomes in both older men and postmenopausal women. Likewise, adjusting for CT abdominal visceral fat generally revealed a favorable association of CT thigh fat with metabolic risk outcomes in women, but not men. The discordance between the DXA and CT results in men is unclear but may be due to sex differences in visceral fat accrual. The mechanisms underlying the protective effect of thigh fat on metabolic risk factors need to be elucidated.     

The role of nerve lysosomal enzymes in the pathogenesis of denervation atrophy

Summary Section of sciatic nerves of rats produced fibrillations within 3 days. Foci of hyalination leading to necrosis corresponded to segments of muscles containing end plates. The electrolyte content, mainly Ca, was increased, NADH₂-TR activity was decreased and membrane ATP-ase was increased.The known increase in hydrolytic enzyme activities in denervated muscles was due to spilling of lysosomal enzymes from degenerating axons at the myoneural junction. This explains the discrepancy between morphological studies indicating paucity of lysosomes in normal muscles and the high hydrolytic enzyme activities in denervation. We propose that denervation changes are at least partly due to the effect of lysosomal spillage from degenerating axons.     

Colorimetric determination of agarose-immobilized proteins by formation of copper-protein complexes

A simple, reliable, and sensitive colorimetric procedure for the determination of proteins bound to agarose is described. The procedure utilizes the capacity of diethyldithiocarbamate to react with cupric ions resulting in a complex of dark yellow color. The extent of reduction in the color, due to chelation of Cu2+ by the immobilized proteins, indicates the amount of protein. The optimum conditions for the determination of immobilized proteins are investigated. The formation of Cu2+-protein complex proceeds stepwise until enough excess of Cu2+ is present to form the final complex. The reliability of the procedure requires that all the protein species, samples and standards, are in the final Cu2+-protein complex form. A comparative study on the determination of different proteins bound to agarose using this method as well as other methods, such as protein balance, modified Lowry reaction, and direct ultraviolet spectrophotometry, is described. The method is substantially more reliable, accurate, and simple than previously described methods.